Maximum Out-of-Pocket (MOOP)

Maximum Out-of-Pocket (MOOP) refers to the maximum amount a beneficiary is obligated to pay for covered healthcare services within a defined period under a health insurance plan. Once this limit is reached, the insurance plan typically covers all remaining eligible expenses for covered services for the remainder of the period. MOOP includes expenses such as deductibles, copayments, and coinsurance, but does not include premiums, out-of-network charges, or services not covered by the plan. MOOP provides financial protection to beneficiaries by capping their out-of-pocket expenses, ensuring they do not face excessive financial burdens due to medical costs.